Search

We herein report a patient with rheumatoid arthritis (RA) who successfully delivered a healthy child with continuous administration of sarilumab throughout pregnancy. She delivered her first child, a healthy boy, following in vitro fertilization-embryo transfer (IVF-ET) while using etanercept and low-dose prednisolone. Disease activity persisted after delivery, so etanercept was switched to sarilumab. She became pregnant by IVF-ET again. Because RA was still active, sarilumab was continued during pregnancy. She delivered a healthy girl at the 38th week of gestation by Caesarean section. No abnormalities were detected at or within 6 months after birth. Sarilumab was safe and effective in this pregnant woman with RA.

Pseudoaneurysm is a potentially life-threatening complication after hepatobiliary pancreatic surgery. Although various measures have been taken to prevent the formation of postoperative pseudoaneurysms, completely avoiding complications can be difficult. An 83-year-old man underwent bile duct resection and systematic regional lymphadenectomies for distal cholangiocarcinoma. Polyethylene glycolic acid mesh with fibrin glue was applied to the pancreas around the distal stump and detached artery to prevent leakage of pancreatic juice and reinforce the arterial wall. Screening contrast-enhanced computed tomography on the 7th postoperative day indicated no pseudoaneurysm. The patient was discharged on the 20th postoperative day after an uneventful course. However, 4 days later, the patient visited the emergency outpatient department with a complaint of fever. Contrast-enhanced computed tomography revealed an abscess formation and a pseudoaneurysm around it. Emergency celiac arteriography revealed two pseudoaneurysms at the left hepatic artery and posterior superior pancreaticoduodenal artery; they were successfully treated with transcatheter arterial embolization using microcoils and covered stent placement. The patient was discharged 9 days after interventional radiology treatment. At the 14 months postoperative follow-up, the patient had no recurrence or stent obstruction. Multiple synchronous pseudoaneurysms are rare; accurately identifying the site by angiography and selecting appropriate treatment for each site is important.

Iguratimod (IGU) is a conventional synthetic disease-modifying drug that has been approved based on its additive effects with methotrexate (MTX) for the treatment of rheumatoid arthritis (RA). The objective of the study is to establish the effectiveness of IGU with versus IGU without MTX irrespective of whether MTX is well tolerated or not by the patients. Disease activity scores in 177 RA patients treated using IGU were retrospectively evaluated at baseline and after 4, 12, and 24 weeks, and adverse events (AEs) were noted. IGU reduced the disease activity parameters, disease activity score (DAS)-ESR, DAS-CRP, the simplified disease activity index (SDAI), and clinical disease activity index (CDAI) in the concomitant MTX and non-MTX, female and male, and young and elderly patient groups after 24 weeks. Multivariate analysis demonstrated that IGU was more effective with concomitant MTX and in elderly and male patients. Severe AEs were observed only in the elderly group: two cases of pneumonia, 1 of pneumocystis pneumonia, 1 of heart failure, and 1 of salivary gland adenoma. IGU is effective for RA, especially with concomitant MTX, and in elderly and male patients.

Objectives Preterm children with severe dyskinetic cerebral palsy due to bilirubin encephalopathy often suffer from marked generalised hypertonus as they age. We performed a questionnaire survey to investigate patient-reported outcomes of treatments for improving their activities of daily life. Methods A mail questionnaire was administered to the caregivers of 67 children with preterm bilirubin encephalopathy aged >4 years. We asked about the type of treatments they received and their efficacy using a five-point subjective scale for the following five domains: motor function, postural stability, sleep, pain, and care burden. The names of oral drugs and their efficacies were also explored. Results The response rate of the questionnaires was 62.7% (42/67), and we analysed the results from 41 validated cases. All children underwent rehabilitation. A total of 30 children received oral drugs, 22 botulinum toxin, 12 orthopaedic surgery, and 3 intrathecal baclofen. Each of these treatments was subjectively reported to be effective in more than half of the recipients for each of the five domains, whereas 23 (56%) required more than two types of treatments other than rehabilitation. Chlordiazepoxide was the most commonly used oral drug, by 28 children (68%), and was discontinued in 7 patients (25%) only. In the sleep domain, the rate of a positive effect was significantly higher for oral drugs (92.7%) than the other treatments (p Conclusion All treatments were partially effective, but their appropriate combination based on a multidisciplinary approach is essential for muscle tone management in children with preterm bilirubin encephalopathy.

Ship breaking and recycling industry (SBRI) loops back scarce ferrous and non-ferrous materials from dismantled ships and also renews the global shipping fleet by treating the end-of-life (EoL) ships. Currently, SBRIs in Bangladesh, India, and Pakistan are dismantling the majority of the EoL ships by open beaching method. Accordingly, ship dismantling carries the blame of releasing potentially toxic elements (PTEs) to the coastal and marine environment risking the food chain through potential bioaccumulation and biomagnification. Health risk assessment associated with PTEs from open beach ship dismantling is scarce. This study aimed at assessing concentrations and seasonal variations of PTEs in soils exposed to the activities of SBRIs for their source apportionment by using contamination factor (CF) and multivariate statistical analysis, while carcinogenic and non-carcinogenic health risks due to the PTEs have also been determined. Soil samples were collected twice—during pre-monsoon and post-monsoon seasons—from three working zones of each of the 15 different ship breaking yards spanning the entire SBRI zone in Bangladesh. Soil contamination was assessed by using the CF, and inverse distance weighting interpolation mapping showed the spatial distribution of metals at SBRI zone in Bangladesh. Multivariate statistical analysis, principal component analysis, and correlation matrix yielded the source apportionment of PTEs. Subsequently, carcinogenic and non-carcinogenic health risks were assessed following the approach recommended by the United States Environmental Protection Agency (USEPA) with uncertainty estimation through Monte Carlo simulation. Contamination levels of PTEs followed Cd > Zn > Cr > Cu > Pb > Ni > Mn > As. Concentrations of Cd, Cr, Mn, and Zn were higher than the maximum allowable regulatory limits at storage zone and also higher as compared with the beaching and cutting zones in general. The contamination index indicated extreme Cd contamination in the area with elevated levels in pre-monsoon. Two principal components (PC) were identified—PC1 (Cd, Cu, Mn, Pb, Zn) and PC2 (As, Cr, Ni) inferring their source segmentation. Indirect soil ingestion is the major possible exposure path to PTEs. The health index indicated the absence of any obvious health effects on the people active at SBRI yards in Bangladesh. The carcinogenic risk was for 6 to 7 persons per 100,000 people which was within the USEPA acceptable range.

To assess the renal and non-renal efficacy of mycophenolate mofetil (MMF) in Japanese patients with systemic lupus erythematosus (SLE). We conducted a retrospective study to assess the renal and non-renal efficacies of MMF in Japanese patients with systemic lupus erythematosus (SLE). We analyzed 14 patients with lupus nephritis (LN) who were given MMF, and 13 patients who received monthly intravenous cyclophosphamide (IVCY) as induction therapy, and a further 19 patients without LN who were treated with MMF, and 13 patients who took tacrolimus (TAC) to reduce glucocorticoid dosages. We assessed the therapeutic effects of each therapeutic regime on renal and non-renal disease manifestations over a six-month period after treatment initiation. Median urine protein to creatinine ratios in the MMF and IVCY groups significantly decreased from 2.2 to 0.7 g/gCr and from 3.3 to 0.5 g/gCr, respectively. Significant improvements in serum immunological variables (serum complements C3 and C4 and the anti-double stranded DNA antibody) and reductions in the SLE disease activity index (SLEDAI) and daily prednisolone dosages were observed in each group with LN. MMF and TAC significantly improved SLEDAI and serum immunological variables and reduced daily prednisolone dosages in patients without LN. The present results demonstrated that MMF might be an effective treatment for renal and non-renal manifestations in Japanese patients with SLE and has potential as a good therapeutic alternative and steroid-sparing agent.

Background Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin with standard distal pancreatectomy for advanced pancreatic body and tail cancer. Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using a mesenteric approach and achieved good outcomes. Methods There are two main considerations for surgical procedures using a mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin). Results From 2017 to 2019, we performed DP-TCR using a mesenteric approach for six patients with advanced pancreatic body and tail cancer. Histopathological radical surgery was possible in all patients who underwent DP-TCR. No Clavien-Dindo grade IIIa or worse perioperative complications were observed in any patient. Conclusions We believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasion.

Background Characteristics of a cancer-positive margin around a resected uncinate process of the pancreas (MUP) due to a pancreticoduodenectomy are difficult to understand by standardized evaluation because of its complex anatomy. The purposes of this study were to subclassify the MUP with tissue marking dyes of different colors and to identify the characteristics of sites that showed positivity for cancer cells in patients with pancreatic head carcinoma who underwent circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Results of this evaluation were used to review operation procedures and perioperative methods. Method We divided the MUP into 4 sections and stained each section with a different color. These sections were the pancreatic head nerve plexus margin (Area A), portal vein groove margin (Area B), superior mesenteric artery margin (Area C), and left of the superior mesenteric artery margin (Area D). The subjects evaluated were 45 patients who had carcinoma of the pancreatic head and were treated with circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Results Of the 45 patients, nine cases (90%) of incomplete resection showed cancer-positivity in the MUP. Among the 4 sections of the MUP, the most cases of positive results [MUP (+) ] were found in Area B, with Area A (+), 0 case; Area B (+), 6 cases; Area C (+), 2 cases; and Area D (+), 3 cases (total, 11 sites in 9 patients). Relapse occurred in 7 of the 9 patients with MUP (+). Local recurrence was observed as initial relapse in all 3 patients with Area D (+). In contrast, the most common site of recurrence other than that in patients with Area D (+) was the liver. Conclusion By subclassifying the MUP with tissue marking dyes of different colors, we could confirm regional characteristics of MUP (+). As a result, circumferential superior mesenteric arterial nerve plexus-preserving pancreticoduodenectomy was able to be performed in R0 operations in selected patients while a better postoperative quality of life was maintained. Furthermore, Area D (+) represents an extension beyond the limit of the local disease and may indicate the need for early aggressive adjuvant chemotherapy.

Waste foundry sand (WFS) from the brass and bronze casting and molding process include various potentially toxic elements (PTEs), such as copper, zinc, tin, and lead. Hence, the utilization of WFS in construction and geotechnical applications evokes environmental concerns due to the rain-induced leaching of PTEs into the groundwater system. The present study investigated the extractive decontamination of WFS using mineral acids, e.g., HCl, H2SO4, or HNO3. Favorable extraction efficiency was achieved with HCl as compared to the other mineral acids, which was further enhanced at high temperatures and increased acid concentrations. The thermodynamic analysis indicated that ≥ 4 mol L−1 of HCl and ≤ 100 °C temperature ensured maximum extraction of PTEs due to the endothermic interactions between the HCl and PTEs. The HCl-treated WFS needed to be rinsed with water to restrict the after treatment elution of PTEs. The hazardous environmental impact of acid-treated WFS was evaluated following the standard leaching test and comparison with legislative recommendations for PTEs, which showed the water-assisted leaching rate of all the PTEs are within the regulatory limits.

Background Single-incision laparoscopic surgery has gained increasing attention due to its potential to improve the benefits of laparoscopic surgery. However, the technique remains technically challenging for most surgeons. We developed a new technique utilizing a needle grasper held in the surgeon's left hand as an alternative to conventional single-incision laparoscopic cholecystectomy (SILC). Patients and methods From August 2011 through May 2013, 29 patients at Nippon Medical School Musashi Kosugi Hospital, with gallbladder stones or polyps underwent single-incision laparoscopic cholecystectomy (SILC) with an additional needle grasper that was held in the surgeon's left hand (SILCAN) and introduced in the right subcostal region without a trocar. We analyzed intraoperative and postoperative outcomes of 29 patients for whom SILCAN was performed and retrospectively compared these outcomes to those of 32 patients who underwent conventional 4-port laparoscopic cholecystectomy (CLC) from January 2011 through May 2013. Results No differences in patient characteristics or intraoperative/postoperative outcomes were observed between the groups. None of the patients in either group required conversion to an open procedure or additional ports. In the SILCAN group, no patients had complications within the first 4 weeks after surgery, with the exception of 1 patient with severe chronic cholecystitis in whom bile duct stenosis developed due to inadvertent clipping of the common hepatic duct. The frequency of postoperative analgesic use was similar in both groups, although none of the patients in the SILCAN group received analgesics for pain from the small, inconspicuous wound in the right subcostal region. Conclusions SILCAN is a safe and feasible alternative to SILC which does not compromise the qualities of CLC. It is less technically challenging, and postoperative pain and cosmesis are comparable to those of conventional SILC.

Background: Freys procedure might be a good alternative to pylorus‑preserving pancreaticoduodenectomy (PPPD for patients with an inflammatory mass of the head of the pancreas because it is technically easy and associated with low morbidity and good pain relief. Purpose: To analyze the short‑term and long‑term outcomes of Freys procedure in comparison with PPPD and to evaluate the efficacy of Freys procedure against preoperative locoregional complications. Patients and Methods: From August 1997 through December 2007 6 patients underwent Freys procedure (as described by Frey and Smith and 10 patients underwent PPPD. The mean follow‑up times were 70.8 months (Freys procedure and 119.8 months (PPPD. Preoperative biliary stricture and duodenal stenosis were observed in 4 and 3 patients respectively of patients undergoing Freys procedure. Pain intensity was assessed with a pain scoring system. Quality of life (QOL was assessed with the European Organization for Research and Treatment of Cancer Quality of‑Life Questionnaire‑Core 30. Exocrine and endocrine pancreatic function was measured during follow‑up. Results: Significant reductions in total pain scores and all QOL scale scores were observed immediately after surgery in all patients (P

Background: In most cases of pancreatic head cancer surgery often results in noncurative resection which is frequently related to inadequate clearance of the mesopancreas. Purpose: The aim of this report is to introduce the surgical technique of left posterior approach pancreaticoduodenectomy (PD with total mesopancreas excision and circumferential lymphadenectomy around the superior mesenteric artery (SMA (LPA‑PD and to examine whether this procedure increases the rate of true curative resection and decreases the rate of locoregional recurrence. Patients and Methods: Nineteen patients underwent standard PD and 19 patients underwent LPA‑PD. The demographic characteristics intraoperative outcomes (mean operative time and mean blood loss postoperative outcomes (complications type of recurrence and survival and pathological findings (R number number of removed regional lymph nodes and positive resection margins were evaluated. Results: The patient characteristics did not differ significantly between the groups. The mean blood loss in the LPA‑PD group was significantly less than that in the standard PD group (p

True splenic cysts are uncommon and are associated with elevated serum and intracystic tumor marker CA 19‑9 levels. A 33‑year‑old woman presented to our hospital with a chief complaint of epigastralgia. Computed tomography of the abdomen showed a 10‑cm cystic lesion in the spleen. The serum carbohydrate antigen (CA 19‑9 level was 3347 U mL (normal

Summary Background Spontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively. Case Report A 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery. Conclusions A more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient’s general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.

The majority of cancer cells harbor homoplasmic somatic mutations in the mitochondrial genome. We show here that mutations in mitochondrial DNA (mtDNA) are responsible for anticancer drug tolerance. We constructed several trans-mitochondrial hybrids (cybrids) with mtDNA derived from human pancreas cancer cell lines CFPAC-1 and CAPAN-2 as well as from healthy individuals. These cybrids contained the different mitochondrial genomes with the common nuclear background. We compared the mutant and wild-type cybrids for resistance against an apoptosis-inducing reagent and anticancer drugs by exposing the cybrids to staurosporine, 5-fluorouracil, and cisplatin in vitro, and found that all mutant cybrids were more resistant to the apoptosis-inducing and anticancer drugs than wild-type cybrids. Next, we transplanted mutant and wild-type cybrids into nude mice to generate tumors. Tumors derived from mutant cybrids were more resistant than those from wild-type cybrids in suppressing tumor growth and inducing massive apoptosis when 5-fluorouracil and cisplatin were administered. To confirm the tolerance of mutant cybrids to anticancer drugs, we transplanted a mixture of mutant and wild-type cybrids at a 1:1 ratio into nude mice and examined the effect by the drugs on the drift of the ratio of mutant and wild-type mtDNA. The mutant mtDNA showed better survival, indicating that mutant cybrids were more resistant to the anticancer drugs. Thus, we propose that mutations in the mitochondrial genome are potential targets for prognosis in the administration of anticancer drugs to cancer patients.

We report a case of giant mucinous cystic neoplasm (MCN) of the pancreas that was successfully treated with laparoscopic surgery. A 29-year-old woman was admitted to our hospital for evaluation of an abdominal tumor that had been detected during a routine medical examination. The tumor was diagnosed as an MCN of the pancreas. We performed laparoscopic distal pancreatectomy and splenectomy. The patient could begin oral feeding 3 days after the operation. No complications occurred either during or after surgery. The outcome in this patient was excellent, with cosmetically acceptable small scars in the skin. Therefore, laparoscopic distal pancreatectomy may become a therapeutic option for patients with large MCNs of the pancreas.

We describe an effective technique for the low-pressure continuous suction of bile and pancreatic juice from the hepatic duct and jejunal limb after major hepatectomy with pancreatoduodenectomy (PD). After hepatectomy and PD, reconstruction is performed by a modification of Child's method. A pancreaticojejunostomy is completed with interrupted sutures between the pancreatic duct and mucosa, without inserting a stent. During hepaticojejunostomy, a 10-F silicone drain with side channels (Blake Silicone Drain; Ethicon, Somerville, NJ, USA) is placed within the hepatic duct via the stump of the jejunal limb to drain bile and pancreatic juice. The drain is connected to a continuous suction device and low suction pressure is started. We found that the low-pressure continuous suction of bile and pancreatic juice from the hepatic duct and jejunal limb was very effective after major hepatectomy with PD.

Medium- and low-volatile organic chlorine (M/LVOCl) and PCDD/Fs in flue gas from various municipal waste incinerators (MWIs) were monitored. The sample for M/LVOCl was collected in an adsorption tube which was thermally desorbed and the amount of chlorine was measured by atomic emission spectrometry (AES) detection using radiofrequency helium plasma. The helium plasma excited chlorine having an optical emission line of 837.6 nm was monitored. The MVOCl and LVOCl were organic chlorine groups whose boiling points (bp) ranged from 70-120 degrees C and 170-270 degrees C, respectively. The compounds having bp 120-170 degrees C were distributed in two tubes. LVOCl correlated well with PCDD/Fs (ng/Nm3, r=0.81) in a wide range of 0.01-100 ng/Nm3 of PCDD/Fs, while the correlation of LVOCl vs. TEQ was less related (r=0.69). These results agreed with the fact that LVOCl monitored the amount of organic chlorine without molecular structure information, which is critical to toxicity. Since the bp of LVOCl was not identical with that of PCDD/Fs, the regression was effected by the conditions of the gas treatment devices. Because most data of 2001 were collected just after the installation of PCDD/Fs in MWIs, the regression of 2001 was slightly different from that of 2002-2003. Eliminating these initial unsteady data, the regression of LVOCl vs. PCDD/Fs became better, giving r= 0.86. Besides having PCDD/Fs as surrogates, M/LVOCl is valuable as a versatile element-selective organic chlorine monitor to improve thermal process control.

The three-dimensional fine structure and the collagenous framework of the anterior chamber angle (chamber angle) of albino rabbits, which does not posses a Schlemm's canal, were examined, with or without NaOH maceration, by scanning electron microscopy. The chamber angle is ill defined because the deep ciliary cleft appears parceled by iris pillars. The collagenous framework of the pectinate ligaments and iris pillars arising from the iris root join to the collagen bundles of the trabecular sheet, and the surface of the ciliary cleft is covered by an endothelial cell layer that screens the trabecular meshwork. Round openings are apparent in the recesses of the ciliary cleft, with junctions between more superficial or deeper trabecular sheets resulting in direct communication between adjacent trabecular spaces. Openings of the angular aqueous plexus/sinus in place of Schlemm's canal were seen on the inner surface of the corneosclera after removing the trabecular meshwork. The framework of the trabecular sheet is basically formed of circumferentially arranged flat collagen bundles and reticularly diverged narrow collagen bundles extending from them. There is no shift between collagen bundles of the trabecular meshwork and the corneosclera, suggesting a frail connection between the two tissues.

The patient, a 56-year-old woman, was found during routine checkup to have a disorder of hepatic function. Abdominal ultrasonography showed an ill-defined hypoechoic mass in the head and body of the pancreas; however, no blood-flow signal was observed within the tumor on Doppler ultrasonography. Abdominal computed tomography showed a low-density area in the arterial and portal venous phases. The lesion was visualized as an area of low signal intensity on both T1- and T2-weighted magnetic resonance images, whereas fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the tumor. Although a preoperative diagnosis was difficult to make, a rapid cytologic examination revealed evidence of a pancreatic endocrine tumor, and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection was performed. Histopathological examination showed tumor cell nests scattered in abundant fibrotic tissue; the tumor cells had proliferated in a cord-like fashion and showed immunostaining for chromogranin A. Staining for fibroblast activation protein α was seen in the fibroblastic cells contained within the fibrous stroma surrounding the tumor cell nests, whereas both the fibroblastic cells in the tumor and those in the stroma showed a high rate of staining for thrombospondin. We presume that tumor-associated fibroblasts were involved in the fibrosis of the tumor stroma.

The patient, a 56-year-old woman, was found during routine checkup to have a disorder of hepatic function. Abdominal ultrasonography showed an ill-defined hypoechoic mass in the head and body of the pancreas; however, no blood-flow signal was observed within the tumor on Doppler ultrasonography. Abdominal computed tomography showed a low-density area in the arterial and portal venous phases. The lesion was visualized as an area of low signal intensity on both T1- and T2-weighted magnetic resonance images, whereas fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the tumor. Although a preoperative diagnosis was difficult to make, a rapid cytologic examination revealed evidence of a pancreatic endocrine tumor, and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection was performed. Histopathological examination showed tumor cell nests scattered in abundant fibrotic tissue; the tumor cells had proliferated in a cord-like fashion and showed immunostaining for chromogranin A. Staining for fibroblast activation protein α was seen in the fibroblastic cells contained within the fibrous stroma surrounding the tumor cell nests, whereas both the fibroblastic cells in the tumor and those in the stroma showed a high rate of staining for thrombospondin. We presume that tumor-associated fibroblasts were involved in the fibrosis of the tumor stroma.

Comparison of eight lambdoid phages, including three Shiga-toxin converting phages, has been carried out with respect to the immunity region, especially the recognition helices of their repressor and CRO proteins on the one hand, and operator sequences on the other. Some as yet unassigned components of the regulatory circuits have been inferred by computer search. The cross immunity phenomenon shown by phages VT2-Sa and lambda is explained on the basis of similarity in their sequences. In addition, the similarity of 933W and HK022 in the sequences of their recognition helices of repressor and CRO, on the one hand, and operators, on the other, has led us to predict that they will have identical or similar immunity specificity. This homology has enabled us also to locate the OL (and consequently PL) of phage 933W that has been thought to be non-existent.

A combination AIDS vaccine approach consisting of priming with adenovirus-HIV-1MN gp160 recombinants followed by boosting with HIV-1SF2 gp120 was evaluated in chimpanzees. Long-lasting protection, requiring only three immunizations, was achieved against a low-dose challenge with the SF2 strain of HIV-1 and a subsequent high-dose SF2 challenge administered 1 year later without an intervening boost. Notably, neutralizing antibody responses against both clinical and laboratory isolates developed in three chimpanzees and persisted until the time of high-dose challenge. The possibility that cytotoxic T-lymphocytes contribute to low-dose protection of a chimpanzee lacking neutralizing antibodies is suggested. Our results validate the live vector priming/subunit booster approach and should stimulate interest in assessing this combination vaccine approach in humans.

Purpose: We investigated the clinicopathological features of borderline resectable invasive carcinomas (BRICs derived from intraductal papillary mucinous neoplasms (IPMNs and examined the significance of the aggressivesurgery firstapproach com pared with the treatment of conventional borderline resectable pancreatic ductal adenocarcinomas (BRPDAs. Patients and Methods: We retrospectively studied 7 patients with BRICs derived from IPMNs and 14 patients with conventional BRPDAs. Several factors were reviewed: initial symptoms preoperative imaging serum level of CA19‑9 perioperative factors pathological findings adjuvant chemotherapy and outcome. Results: All BRICs derived from IPMN were huge tumors (more than 3 cm in diameter suspected to involve

We report a rare case of adenocarcinoma of the minor papilla of the duodenum treated with transduodenal minor papillectomy. A 64-year-old woman was treated for an asymptomatic duodenal tumor detected on gastroduodenoscopy. Endoscopy showed a 15-mm sessile mass in the descending duodenum proximal to the major papilla. The major papilla was a villous 24-mm-diameter polypoid tumor. Histopathologic examination of the biopsy specimen showed tubular adenoma with moderate epithelial atypia. Transduodenal major and minor papillectomies were performed. The orifice of the duct of Santorini and the pancreatic duct were re-approximated to the duodenal wall to prevent acute pancreatitis caused by scarring and stenosis of the duct orifice. Histological findings were consistent with well-differentiated adenocarcinoma limited to the minor duodenal papilla, without infiltration of the duodenal wall submucosa, and confirmed complete resection. The patient had an uneventful postoperative course and has remained asymptomatic, without evidence of tumor recurrence or stenosis of the pancreatic duct orifice, for 4 years.

Although hilar cholangioma is the most common cause of stricture of the hilar bile duct, several diseases can contribute to stenosis. Here, we report on a patient with immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC) of the hilar bile duct arising from obstructive jaundice. The patient had undergone laparoscopic cholecystectomy for the removal of gallstones. The differential diagnosis for icterus included hilar cholangiocarcinoma, primary sclerosing cholangitis, IgG4 sclerosing cholangitis, ischemic bile duct stenosis, a complication of cholecystitis, amputation neuroma, and iatrogenic stenosis. Numerous examinations were performed, but a definite diagnosis remained elusive. Because cholangiocarcinoma could not be ruled out, we proposed surgical resection. The patient subsequently underwent extended right liver lobectomy and intrahepatic cholangiojejunostomy. Pathological examination revealed numerous inflammatory cell infiltrates resembling IgG4-positive antibody plasma cells in the stromal layer of the stenotic bile duct walls. Hypertrophy of the nerve fiber fascicles was not observed. The serum IgG4 level of the patient was within the normal range. Few reports of IgG4-SC with a normal serum IgG4 level have been published. When this condition presents as it did in the present case, establishing a definite diagnosis can be difficult.

The three-dimensional architecture of the collagen fibrillar network forming the lamina cribrosa of the optic disc and the associated septal plates of the anterior part of the optic nerve was investigated using monkey eyeballs treated by the NaOH cell-maceration procedure and scanning electron microscopy. Arising from the scleral collagen fibrils branches joined together to form thick bundles of collagen in lamina plates encompassing hundreds of pores. More than ten plates were observed stacked on top of each other forming the pore channels. Adjacent piled up plates were interconnected with branching collagen fibrils. Septal plates derived from pia mater collagen fibrils were formed by radially and obliquely arranged thick bundles of collagen piled up longitudinally in the optic nerve and merging into the most posterior lamina plate. In the septal plates many ovally shaped windows were observed, suggesting branching and regional irregularity in the shape of the myelinated nerve fiber bundle. Pia mater and dura mater collagen fibrils of the optic nerve merged into the outer layer of the scleral collagen fibris. The present results suggest that the observed three-dimensional network of collagen fibrils constitutes the skeletal framework of these tissues maintaining their morphological specificity and providing a suitable microenvironment for their physiological functions.

Deconjugation reactions of natural estrogen conjugates were studied here by three different solutions of 1 M hydrochloric acid (HCl) in methanol. Estrogen sulfates could be easily deconjugated even at low temperature, while deconjugation conditions of estrogen glucuronides required a higher temperature and longer time. For 1 M HCl in methanol with 8% water, the deconjugation efficiencies of the three studied estrogen glucuronides were below 59.4% at 80 degrees C for 360 min, while the corresponding deconjugation efficiencies were above 80.6% for anhydrous HCl methanol at 80 degrees C for 210 min, which suggested trace water in the solution of 1 M HCl methanol retarded the deconjugation rates of estrogen glucuronides. On the other hand, their corresponding deconjugation rates increased with the addition of ethyl acetate, and their corresponding deconjugation efficiencies were above 86.7% at 80 degrees C for 120 min. As water is a highly polar solution, and the polarity of ethyl acetate is lower than that of methanol, this may suggest that a low polar substance would favor the reaction, while a highly polar solution would prohibit the reaction. All reactions were in pseudo first-order, and higher temperature increased the reaction rate. Finally, a GC-MS method for simultaneous analysis of free estrogens and estrogen conjugates in wastewater with acid-catalyzed solvolysis was developed, and satisfactory recovery efficiencies were obtained by spiking the standard target chemicals into the influent and effluent of one municipal wastewater treatment plant (WWTP), which demonstrated the feasibility of the developed method. Compared with enzymatic hydrolysis, the acid-catalyzed solvolysis method developed here to deconjugate estrogen conjugates is cost effective and time-saving, giving it a greater potential for use with environmental samples.

A primitive neuroectodermal tumor (PNET) is a small round cell tumor that arises from the nerve crest. This tumor usually occurs in the central nervous system or soft tissue, but it can occur in the kidney in rare cases. Herein we report a case with severe multiple liver metastases after surgery for right renal PNET. The patient was a 21-year-old man with a chief complaint of right abdominal pain. Hemorrhage in a right renal malignant tumor was diagnosed, and radical nephrectomy was performed. Histopathology showed bare nuclear round atypical cells with a scarce cytoplasm proliferating like a seat and nest. Some of the cells formed a rosette structure and the tumor cells were positive for CD99, leading to diagnosis of PNET. Severe multiple liver metastases occurred 6 months after surgery, and six courses of chemotherapy with ifosfamide, etoposide and doxorubicin were performed. After this treatment, residual tumor was removed, but the tumor cells were absent histologically.

Adenovirus type 7 vaccine strain was engineered to express foreign antigens from both the E 3 early promoter in the E 3 region and the major late promoter inserted between the E 4 region and the right inverted terminal repeat. This multiple expression vector was used to express hepatitis B core antigen (HBcAg), hepatits B e antigen (HBeAg), and hepatitis B surface antigen (HBsAg). The gene inserted in the E 3 region was derived from the core gene of the hepatitis B virus genome. When the precore region was present, an immunoreactive group of proteins with molecular weights ranging from 15,000 to 19,000 was secreted into the media. Velocity sedimentation centrifugation of media and lysates from cells infected with recombinants containing the core gene with the precore region resulted in peaks of HBeAg at the top of the gradient where authentic HBeAg should be found. In addition to the core gene in the E 3 region, the surface antigen gene of hepatitis B virus was inserted behind the major late promoter in the E 4 region resulting in an adeno-hepatitis recombinant virus capable of expressing both the core gene and the HBsAg cells. Cells infected with the adeno-hepatitis recombinants could also be stained with peroxidase-conjugates after reacting to antibody against HBcAg. Inoculation of dogs with the recombinant viruses which contained the core gene, with and without the precore sequence, resulted in a significant antibody response to HBcAg/HBeAg. The dogs also produced a significant antibody response to HBsAg as well as neutralizing antibody to adenovirus.

We have carried out an exhaustive search of the literature and databases on DNA sequences of verotoxin genes, most of which are carried by prophages and only two described as chromosomal: one is from Shigella dysenteriae, and the other from Escherichia coli. A common feature of these cases is the existence of an insertion sequence (IS) upstream of the toxin genes." The authors of these papers speculate that the IS is probably a component of a composite transposon bracketing the verotoxin genes, and is responsible for moving about of the verotoxin gene within the Shigella or E. coli genome, resulting in many copies of the verotoxin gene within a single genome. However, we think there is another way to look at this close location of an insertion element upstream of the toxin genes (Fig. 1). On close scrutiny, the region between the IS and the toxin genes has high homology with a phage sequence, strongly suggesting that it is derived from a prophage that included the toxin genes. The region downstream of the toxin genes is also homologous to a phage sequence (Fig. 2). We propose that the IS's were responsible for the defectiveness of the prophage; either by disruption of the prophage by insertion within the prophage, or by DNA deletion starting from one end of the IS outward, extending into part of the prophage. In other cases in Shigella and E. coli, where the verotoxin genes are believed to reside in the chromosome rather than in the prophage although the DNA sequence of their neighborhood is not yet available, they are unusual in that they are all sensitive to the so-called SOS signals. ~ This indicates that they are subject to the SOS response,' which is controlled by the LexA gene, and are therefore possibly contained in a prophage. In the latter case, the toxin production was induced by mitomycin C simultaneously with a lysogenic phage, but the phage genome did not contain the toxin gene. The case of the verotoxin II operon (coupled with a reporter gene, bacterial alkaline phosphatase) studied by Miihldorfer et al. is especially suggestive, although it

Malignant fibrous histiocytoma of the liver is an extremely rare tumor. A 43-year-old woman was admitted with an enlargement of the abdomen and a feeling of general fatigue. A clinical examination revealed a right liver giant cystic tumor (18.5 × 22 cm). The cystic tumor, which contained a solid component, occupied almost the entire right lobe of the liver, and a solid S4 tumor was also observed. A blood examination revealed severe anemia and mild liver dysfunction. During hospitalization intratumor bleeding occurred. A right lobectomy of the liver and lymph node dissection was performed after transcatheter arterial embolization. Histopathologically, the tumor was diagnosed as a primary storiform-pleomorphic-type malignant fibrous histiocytoma of the liver. One year after the radical operation, the patient developed recurrences in other organs. She received 17 cycles of chemotherapy with etoposide, ifosfamide, and cisplatin. The recurrent tumors decreased in size, but new recurrences in other organs occurred. The patient died of respiratory failure 4 years and 2 months after the initial operation.

We report on two patients with gastric tumors (early cancer and adema) and diabetes mellitus who were treated with argon plasma coagulation (APC) therapy. Case 1. A 78-year-old woman visited the Nippon Medical School Musashi Kosugi Hospital because of epigastric pain. An early gastric cancer (IIc) in the anterior wall of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 18 years and had injected insulin (NovoRapid 30 Mix, 72 units/day) by herself everyday for 10 years. Case 2. A 61-year-old man was referred to our hospital because of a gastric tumor. A gastric adenoma in the anterior of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 12 years and had been taking oral medication for 2 years. Endoscopic APC was performed in both patients to remove the gastric tumors. These patients have been well for 28 months and 30 months, respectively, after undergoing APC treatment. APC therapy appears to be a safe and useful treatment for patients with diabetes and gastric mucosal lesions.

We conducted a clinicopathological study of cases of gastric carcinoma with pyloric stenosis and examined treatment outcomes and the prognosis of cases of stage IV gastric carcinoma with pyloric stenosis and the validity of gastrectomy as palliative surgery in these cases. The outcomes of 49 surgeries for gastric carcinoma with pyloric stenosis were compared with those of 671 surgeries for gastric carcinoma without pyloric stenosis. The diagnosis of pyloric stenosis was confirmed with both upper gastrointestinal endoscopy and an upper gastrointestinal barium series. The frequency of pyloric stenosis in patients with gastric carcinoma was 7.3%. Serosal invasion was observed in about 70% of all cases. Of these cases, 53.1% were classified as stage IV. The resection rate was 73.5%, and the resection was classified as curative in 44.9% of cases. The incidence of complications after surgery in cases of stage IV gastric carcinoma was 47.1%. The median survival time was significantly greater in patients undergoing resection group than in those not undergoing resection (p=0.025). Most patients with gastric cancer and pyloric stenosis can be considered to have stage IV disease, which is associated with high rates of morbidity and mortality; thus, prevention of complications, and therefore, avoidance of gastrectomy is recommended in such patients. Nonetheless, in this study, gastrectomy was shown to improve prognoses in these patients.

Sensitivity to the bitter taste of chloramphenicol was studied in 860 students, 620 males and 240 females. About 8.6% of them were insensitive to this bitter taste. Familial lineage studies were carried out on a subset of these students, and the results suggested that the sensitivity or insensitivity was controlled by a pair of autosomal Mendelian genes, with the sensitive gene being dominant over the insensitive.

We describe a case with multiple gastric carcinoid tumors combined with early gastric carcinoma originated from the type A gastritis-affected tissue. Microcarcinoid foci were observed from the deeper layers of the propria mucosa to the submucosa and were surrounded by endocrine cell micronests (ECMs), while carcinoma was limited within the mucosa. Serum gastrin level was high (1,100 pg/ml) pre-operatively but returned to normal (44 pg/ml) post-operatively. It suggested that the longstanding hypergastrinemia may have played a causative role in the development of multiple carcinoids and cancer. Surgical treatment was considered essential for treatment in this case of coincident multiple carcinoid tumors and cancer.

A 3-4S DNA polymerase was partially purified from a fraction with endogenous RNA-directed DNA polymerase activity isolated from normal chicken embryos. The activity of this 3-4S DNA polymerase was not neutralized either by an antibody prepared against DNA polymerase purified from avian myeloblastosis virus or by an antibody prepared against a 10S DNA polymerase purified from the soluble fraction of chicken embryos. After removal of ribonuclease activity, the 3-4S DNA polymerase could utilize avian RNA tumor virus RNA as a template-primer. The response of this 3-4S DNA polymerase to synthetic template-primers was very similar to that of DNA polymerase from avian sarcoma virus and different from that of soluble chicken DNA polymerase. The existence of a chicken DNA polymerase which can utilize RNA as well as DNA as a template-primer for DNA synthesis suggests that this type of DNA polymerase could play a role in information transfer from RNA to DNA in normal cells, as suggested by the “ protovirus hypothesis. ”

Virions of Schmidt-Ruppin avian sarcoma virus have both polynucleotide ligase activity and DNA exonuclease activity. These enzymes complete the machinery necessary to transfer information from RNA to double stranded DNA integrated in the host DNA.